1. (1) An insurer filing a group accident and health insurance filing shall comply with:

   1. (a) Title 31A, Chapter 22, Part 6, Accident and Health Insurance;
   2. (b) Title 31A, Chapter 22, Part 7, Group Accident and Health Insurance;
   3. (c) Title 31A, Chapter 22, Part 14, Long-Term Care Insurance Standards;
   4. (d) Title 31A, Chapter 22, Part 20, Limited Long-Term Care Insurance Act;
   5. (e) Title 31A, Chapter 30, Individual, Small Employer, and Group Health Insurance Act;
   6. (f) Title 31A, Chapter 45, Managed Care Organizations;
   7. (g) Rule R590-85;

   8. (h) Rule R590-122;

      1. (i) Rule R590-126;
   9. (j) Rule R590-131;

   10. (k) Rule R590-146;

       1. (l) Rule R590-148;
   11. (m) Rule R590-192;
   12. (n) Rule R590-203;
   13. (o) Rule R590-215;
   14. (p) Rule R590-277;
   15. (q) Rule R590-283; and
   16. (r) Rule R590-285.

2. (2) An insurer filing a group health benefit plan filing shall comply with:

   1. (a) Rule R590-167;
   2. (b) Rule R590-176;
   3. (c) Rule R590-194;
   4. (d) Rule R590-200;
   5. (e) Rule R590-233;
   6. (f) Rule R590-237;
   7. (g) Rule R590-247;

   8. (h) Rule R590-259;

      1. (i) Rule R590-261;
   9. (j) Rule R590-266;

   10. (k) Rule R590-271;

       1. (l) Rule R590-277; and
   11. (m) Section R590-220-10.

3. (3) An insurer shall determine if a group is an eligible group or a discretionary group.

   1. (a) Eligible Group.

      1. (i) A filing for an eligible group shall include a compliant Utah Accident and Health Insurance Group Questionnaire.
      2. (ii) A questionnaire shall be completed for each eligible group under Section 31A-22-701.
      3. (iii) When a filing applies to more than one employer or employee group, only one questionnaire is required.
      4. (iv) A filing for a bona fide employer association shall include a compliant Utah Bona Fide Employer Association Group Authorization Questionnaire.
      5. (v) A filing for a non-employer group shall comply with Rule R590-126.

   2. (b) Discretionary Group.

      1. (i) If a group is not an eligible group, specific discretionary group authorization shall be obtained.

      2. (ii) If a form filing is submitted without discretionary group authorization, the filing shall be rejected.

         1. (A) A filing may not include a rate or form filing before receiving discretionary group authorization.
         2. (B) If a rate or form filing is submitted without discretionary group authorization, the filing shall be rejected.
         3. (C) A discretionary group authorization filing may include a copy of the policy or certificate for informational purposes only, and such an inclusion does not satisfy a form filing requirement.
      3. (iii) To obtain discretionary group authorization, a compliant Utah Accident and Health Insurance Request for Discretionary Group Authorization shall be submitted.
      4. (iv) A change to an authorized discretionary group shall be submitted to the department within 30 days of the change.
      5. (v) The commissioner may periodically re-evaluate a group's authorization.

      6. (vi)(A) An insurer shall file a separate discretionary group authorization to add another TOI to a previously authorized group.

         1. (B) The discretionary group authorization shall specify the TOI products that a discretionary group may offer.

KEY: health insurance filings

Date of Last Change: July 21, 2023

Notice of Continuation: February 7, 2024

Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-201.1; 31A-2-202; 31A-22-605; 31A-22-620; 31A-30-106